Anxiety and specific structure of worries of patients who undergo abdominal surgery

Mizue Shiromaru (Showa University)

Takehiko Ito(Wako University)take@wako.ac.jp

• The 1st International Nursing Research Conference of World Academy of Nursing Science

• 2009/09/20 13:00-14:00• Kobe (Poster 10020)

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 [Purpose]

　 The purpose of this study is exploratory demonstration of the structure of more abstract anxiety, by focusing on worries that 　 cause the anxiety state of patients who undergo abdominal surgery includingthe digestive system disease and by clarifying the specific details of worries and their interrelation

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[Method]

　 　 The participants consisted of103 patients who underwent surgeries at Ward B of a

　Ｕ niversity hospital; average age: 59.6 years old, 66 males and 37 females.

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　 Table1 Subject characteristics

　 　 　 　 　 n=103 　

　 　 no malignancy (n=34 ） malignancy(n=69 ）

　 　 mean/number （ SD) ％ mean/number （ SD) ％　 　 　 p

Age(years) 　 52.1 12.2 63.3 11.3 　　p<.005

Sex Male

　 20　 46　 　

Female　 14　 23　 　operation laparotomy

9　 42　 　

endoscope　 25　 27　 p<.005

Disease 　Gallstone 胆石：25

　 Colon 大腸 /rectum 直腸 cancer ：31

Other ： 9 Gastric cancer 胃癌： 25Esophageal cancer 食道癌： 5

　 　　 　 Other ： 7

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[Ethical consideration]

　 This study was approved by the hospital and conducted with participants' consent and the ethical standards.

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Table 2 　　ＢＥＦＯＲＥ　ＳＵＲＧＥＲＹ　－　WORRIES

　 　 　

Ｐａｔｉｅｎｔ Mean SD

１ Feel apprehension as to the result of the surgery 103 2.11 ± .82２ Concerned about physical discomfort after the surgery 103 2.35 ± .88３ Have acquired information on the surgery* 100 2.46 ± １ .06

４ Worried about financial aspect where surgery and hospitalization are concerned 99 1.76 ± .87

５ Worried about family where surgery and hospitalization are concerned 102 2.16 ± .99６ Feel anxious regarding job during hospitalization 103 2.00 ±1.11７ Concerned about changes to physical condition because of the surgery

(wounds, having tubes inserted etc) 101 2.23 ± .95

８Satisfied with the medical staff* 98 1.67 ± .89

９ Feel irritated by the change in environment caused by hospitalization 103 1.57 ± .79１０ Feel anxious regarding current physical pain 101 1.59 ± 81

１１ Mentally prepared for the anesthetic* 99 2.31 ±1.16

１２ Worried about post-surgery treatment 103 2.08 ± .93

１３ Mentally prepared for the surgery* 103 2.10 ±1.10

　　 　 * Inverted items 　 　 　

[Results 　①　 ] hardly:1,often:2, frequently:3,always:4

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　Ｔａｂｌｅ　 2 　　　　　　　　　ＡＦＴＥＲ　ＳＵＲＧＥＲＹ　 :WORRIES

　 　 　

　　　　

NMean SD

１ Satisfied with the result of the surgery* 99 1.32 ± .47２ Worried about returning to work after leaving hospital 102 1.47 ± .51３ Feel anxious regarding current physical condition 103 1.62 ± .49４ Worried about diet and eating habits after leaving the hospital 103 1.67 ± .47５ Satisfied with the medical staff* 102 1.30 ± .45６ Worried about family matters after leaving the hospital 103 1.16 ± .36７ Feel irritated by the current in-hospital environment 103 1.38 ± .49８ Feel confident of gradually readjusting to society after leaving hospital* 101 1.56 ± .50９ Feel like sufficient sleep is attained* 103 1.67 ± .47１０ Feel happy to be able to talk to other people* 103 1.63 ± .48

１１ Worried about financial situation after leaving the hospital 102 1.37 ± .49

１２ Feel anxious about daily life (appearance / dress etc) after leaving hospital 103 1.33 ± .47

１３ Feel confident about daily life (appearance / dress etc) at the present time* 103 1.58 ± .50

１４ Feel like lacking in strength at the present time 102 1.77 ± .43

１５ Feel hope toward the future due to having the surgery* 103 1.55 ± .50

*Inverted items

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[Results 　②　 ]

１） The scale point of worries after surgery had correlation with worries to the social life after hospital discharge (r = .059, p < .001) and the daily life after hospital discharge (r=.057, p < .001), suggesting the necessity of support with expanded views to reconstruct the life after hospital discharge.  

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[Results 　　③ ] •  As a result of MDS (Multi-Dimensional Scaling)

interpretation in reference to the cluster analysis in order to understand similarities among each item of worries before and after surgery and their structure, they were successfully categorized into five:

　① satisfaction to responses,  ②current worries, ③mental preparedness,

　 ④ worries to results,  and 　⑤ worries about relationship after surgery.

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B1_B2_

B3

B4_

B5_

B6_

B7

B8_

B10_

B11_

B12_

B14_

B15

A1

A2

A3A4

A5

A6

A8

A9

A10

A11A12

A13A15

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- 2

- 1

0

1

2

3

- 2 - 1 0 1 2 3次元

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次元１

Fig 1. Result of MDS (Multi-Dimensional Scaling)

　　　　　　　　　　　④

③

⑤

②

①

Stress=.14 RSQ=.93

BEFORE 　ＳＵＲＧＥＲＹ : WORRIES

1.Feel apprehension as to the result of the surgery

2 ．　Concerned about physical discomfort after the surgery

3.Have acquired information on the surgery*

4.Worried about financial aspect where surgery and hospitalization are concerned

5.Worried about family where surgery and hospitalization are concerned

6. Feel anxious regarding job during hospitalization

7.Concerned about changes to physical condition because of the surgery (wounds, having tubes inserted etc)

8.Satisfied with the medical staff*

9.Feel irritated by the change in environment caused by hospitalization

10.Feel anxious regarding current physical pain

11.Mentally prepared for the anesthetic*

12.Worried about post-surgery treatment

13.Mentally prepared for the surgery*

　ＡＦＴＥＲ　ＳＵＲＧＥＲＹ　 :WORRIES

1.Satisfied with the result of the surgery*

2.Worried about returning to work after leaving hospital

3.Feel anxious regarding current physical condition

4.Worried about diet and eating habits after leaving the hospital

5.Satisfied with the medical staff*

6.Worried about family matters after leaving the hospital

7.Feel irritated by the current in-hospitalenvironment

8. Feel confident of gradually readjusting to society after leaving hospital*

9.Feel like sufficient sleep is attained*

10. Feel happy to be able to talk to other people*

11.Worried about financial situation after leaving the hospital

12.Feel anxious about daily life (appearance / dress etc) after leaving hospital

13.Feel confident about daily life (appearance / dress etc) at the present time*

14.Feel like lacking in strength at the present time

15.Feel hope toward the future due to having the surgery*

Results 　　③

In terms of relationship of worries with existence of malignant tumors,

operative procedures, sex and age, the influence of age was found to be

statistically significant.

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[Conclusion]

　 The results suggest the importance of nursing for helping patients reduce worries and anxiety based on their needs and psychological states before and after surgery, including proper information of surgery and recovery process.